More problems for weekend gastrointestinal surgery

NEW YORK (Reuters Health) - Patients who have emergency surgery to treat a digestive problem called diverticulitis are slightly more likely to have complications following the procedure if they went to the hospital on the weekend, according to a new study.

Dr. Mathias Worni, the lead author of the study, said the findings could be due to a number of factors.

"First, I think more severe cases could (be admitted) on the weekend. Plus, less experienced surgeons could be working on the weekend," said Worni, who is affiliated with Duke University and Inselspital Bern in Switzerland.

Diverticulitis adds to the list of conditions that have better results when treated during the week, including kidney injury, heart attack, stroke and brain hemorrhage (see Reuters Health reports of July 10, 2012).

Other studies have found that, in general, people are also more likely to die if they are admitted to the hospital on the weekend (see Reuters Health reports of May 20, 2011, July 6, 2010).

It's not entirely clear why weekend patients tend to fare worse, although some researchers have proposed that fewer medical providers on duty and less access to resources, such as specialized machines that might not be staffed on weekends, compromise the quality of care.

TREATMENT CAN VARY

Worni and his colleagues wanted to see if diverticulitis patients also experience the weekend effect.

They collected information from a U.S. database of hospital inpatients, including close to 32,000 patients who had emergency surgery to treat diverticulitis. About 20,000 people have urgent surgery for the problem every year, according to the authors.

Diverticulitis is a common digestive ailment, in which the intestine develops inflamed pockets that can cause pain, gas and vomiting.

In severe cases, patients have the affected portion of their intestine surgically removed.

The surgeon either reconnects the remaining intestine to the rectum, which maintains a continuous digestive tract, or creates a hole in the abdomen where the intestine empties into a colostomy bag on the outside of the body.

The colostomy surgery, called a Hartmann procedure, is technically less difficult, but it's also recommended for the most severe cases of diverticulitis.

During the weekdays, Worni's group found, 46 percent of patients had the reconnecting surgery (called a primary anastomosis) and 54 percent ended up with a colostomy.

On Saturdays and Sundays, just 35 percent of patients had the reconnecting surgery and 65 percent had a colostomy.

Worni said it's possible that, because fewer specialists are staffed on the weekends, the less experienced surgeons opted for the simpler procedure.

"Using our data we can't confirm this was really the case. We can't know if surgeons on the weekend were really the less experienced surgeons," he added.

It's also possible that the surgeons opted for the colostomy surgery because the patients really needed it, and their conditions tended to be more serious.

"It's hard to know whether, for whatever reason, patients over the weekend present with more severe disease, so they end up with a higher rate of colostomy," said Dr. Sang Lee, an associate professor of surgery at New York Presbyterian Hospital and Weill-Cornell Medical College, who was not involved in the study.

Worni's team, who published their findings in the Archives of Surgery, also found that weekend patients were 10 percent more likely to have problems, such as a wound complication, after the surgery.

DON'T DELAY

Worni said that too could be related to the same reasons patients are more likely to have a colostomy procedure over the weekend.

"If you're starting with a more severe disease, I think the risk that you're going to have a complication after the surgery is higher," he said. Also, if there are less experienced surgeons and other staff on the weekends "maybe it can happen that complications are a little higher," he said.

What was reassuring, Worni said, is that patients had the same chance of dying if they had surgery on a weekend or a weekday.

Lee said that overall, the study "doesn't mean there's any lesser care given over the weekend."

Worni said it will be important for future studies to determine why there are differences between weekends and weekdays, so that they can be addressed.

He also said patients should not hesitate to go to the hospital on a weekend if they have an urgent need, because waiting for a weekday could worsen the problem.

"I really think you should not delay this just to overcome what we found in this analysis, because then I think the outcomes would be even worse," he said.